Hair Transplant BOOKED - Looking for some support

[SD1984]

Well I have finally booked my hair transplant, and though I wish many things were different going into it, I know this is basically my last resort and after years of (albeit on and off) extensive research, as well as going with a very well known top surgeon, I feel pretty comfortable. I am not going to name the clinic here, but it is a place that has been VERY well spoken about on here and many other places, for what that's worth. This will likely be my final topic until my surgery, which is not until SPRING of 2022. This actually ended up being fine by me, as it gives me one last chance to possibly stabilize my hair loss with oral minoxidil. If it works, amazing. Less surgery to do. If it doesn't, well then it's the opposite. 

As you may recall, and from a previous thread, I finally gave Finasteride the chance it deserved months ago, and the medication simply did not agree with my body. Over the years I have tried virtually every other thing possible, all to no avail. I am 37 and have been living through this hell for 15 years now, though only in the last 2 years have things taken a rather drastic turn for the worse with my hair. At this moment and at this age I feel the loss has finally slowed down. Below are all the factors about me and my hair as well as possible plans for the transplant. Because I am in the USA and am going overseas for the HT, there was no in person consult and there is only a general idea of what will happen. Nothing is final until that morning as many of us kind of know. First, the bad news, and unfortunately, there is plenty of it aside from Fin not working for me:

Cons:

-I have somewhat significant retrograde alopecia which has limited my donor capacity. Instead of the average of around 8k grafts, I estimate, and with others here agreeing, that I have around a 4,000 to 5,000 graft max capacity

-There is literally no part of the top my scalp that is not thinning. While the photos below may make it appear that I have a ton of hair left, the photos are skewed as my hair is extremely dark and wavy (two pro's that I will mention later). The forelock is the only part of my hair left that is ever so sightly "dense". You can see my scalp everywhere. My temple points have also thinned out which is common but I do not think I'm going to worry about them, unless maybe it only means a few grafts in each to get some sort of structure back in them. 

-Aside from drastic loss up top, even my lateral humps have thinned out as well to the point where they will need some form of conservative reconstruction.

-My fathers side of the family has serious hair loss. A bunch of NW'6's including my Father, one Norwood 7 (my grandfather) and one NW3 (my cousin! Lucky guy!). It should be noted that while my Father is NW6, the guy has the thickest sides and back you've ever seen. Humps intact. With this, the reality is that unless oral minox is a godsend for me, I will have to return for what will be at least one more surgery in the future

 

Pros:

-I have absolutely ZERO expectations for anything crazy and know the days of me having a full head of hair are long gone and impossible to recreate. I don't care about my crown at ALL right now and would be over the moon with just a decent frontal third and my face reframed again for the first time in many years. Me and the surgeon have discussed and agreed to go with an extreme conservative route, especially given the limited donor capacity, starting with a high hairline. I am aware that hair fibers will likely have to be a part of my life for a very long time and I am perfectly fine with that.

-This is more of a "pro", but at 37, at this stage my pattern of hair loss is pretty much set and visible. NW5a / NW6, so there will be no shock/surprisess down the road.

-My hair characterisitcs are great. Aside from my donor hair being what I beleive is pretty thick/high microns, my hair in general is SUPER dark brown as well as very wavy. This means less grafts can mean more of a visual coverage. You can get an idea of this my looking at my photos where it appears I have more hair than I really do.

-Unlike a few of the NW6's in my family, I have a rather narrow face and head in general, making for a good situation as far as being conservative for grafts. At its absolute longest measurement (as you will see in the photo below), the top of my scalp measures only 5.5 inches which I believe is on the lower end of most. The same can be said up front at my hairline area.

-I am opened minded as can be, whether that means SMP in my crown down the road or even a partial hair system.

-My beard is insanely coarse, with probably another couple thousand grafts possible to take from it, if necessary

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Below are all updated photos of my sides, back, top as well as an outline for a possible plan come surgery day if in the event oral minoxidil doesn't work magic and thicken up my hair over the course of the next 6-8 months. The current plan is to do somewhere around the ball park of 2000 grafts.

Any thoughts, advice or support would be greatly appreciated.

Edited September 3, 2021 by SD1984

[Britanium]

Very sensible planning ! Good luck 🤞 I know it’s a while away but it’s going to be worth the wait 🙂

[JDEE0]

Hey man, just commented on your other post and then saw this, but it sounds like a very sensible plan that you've thought out over a long period of time, so hats off to you.

It's a shame you couldn't tolerate fin, but oral minoxidil should help out for a while. I'm hopeful we will have a number of new treatments, that all look very promising, available in the next 5-10 years. No one knows of course, but we're in a time unlike any other before with prospective options on the horizon. 

That would be my only reservation for you though, is that you do have a clear pattern that in reality is going to progress without the use of meds. However, with that said, you have made it clear you're aware of all of this and your expectations aren't unreasonable at all. You know that one day you might have a bare crown etc. And besides, I do think there will be more options in the near future. Maybe you could try a Dutasteride Mesotherapy treatment for now?

At the end of the day, I think it'll be successful and you're gonna look good.

I'll say this, you've done a lot of research and put a lot of thought into this; I know I'd regret never going ahead with it 20 years down the line far more than getting there and beginning to regret it due to further loss etc if I was you!

You've done what you can, and you're being more than reasonable. Sometimes you just have to stick to your guns and not worry too much past a certain point - life is too short

[SD1984]

5 hours ago, JDEE0 said:

I'm hopeful we will have a number of new treatments, that all look very promising, available in the next 5-10 years. No one knows of course, but we're in a time unlike any other before with prospective options on the horizon. 

Like what?

Thanks for your reply.

[Gatsby]

Firstly you have done extremely well to hold out until 37 before pulling the trigger on surgery. So many patients are ruined (not unlike myself) for impatience in having a hair transplant at a young age and you should be commended for it.  Also for 37 you still have a remarkable amount of hair. Many men are bald by 30 or earlier. You've obviously done your research and looked at all the benefits and pitfalls that can happen with surgery. Wishing you all the best. 👍

[JDEE0]

2 minutes ago, SD1984 said:

Like what?

Thanks for your reply.

Well, I don't want to pre-emptively get anyones hopes up, so this comes with the disclaimer that there is certainly no guarantee any of these will actually come to market, but here's what I'm optimistic about. In a somewhat descending order of what will be most effective/life changing for anyone suffering from MPB. (you can read about all of these in depth at hairlosstalk.com under the new research section, there are threads for each with lots of discussion and knowledgable people).

1) Bayer Prolactin Antibody/HM-115: a series of injections over the course of 6 months that has re-grown essentially full heads of hair in the completely bald scalps (that had been that way for decades in some subjects) of macaques - these monkeys suffer from Androgenetic alopecia just as we do, same genetic cause as in humans. Effects lasted for more than 4 years, so in theory you would need some injections every week for a few months every X amount of years and regrow all your hair/never go bald. Soon to go into Phase 2 trials in the US and already underway in China I believe - seems to be side effect free so far and doesn't interfere with androgens. 

2) Kintor 20029 AR degrader - this one will be a while off If it is to come through, probably closer to 10 years, but would essentially destroy the AR in the follicle so that nothing can bind to it, DHT or T, with no systemic effect on hormone levels. Would alone most likely prevent any further loss for anyone who used it and would probably be a functional cure for anyone yet to or at the ver beginning stages of baldness.

3) OliX AR mRNA Silencing product 

4) Kintors other topical which is quickly going through Clinical trials - KY19382 - and Breezula. (both should do a similar thing).

then there's all the WNT pathway stuff etc, there's a lot on Hairlosstalk as I say, so dive into that rabbit hole if you want to know what is potentially on the horizon, but it looks promising.

[SD1984]

What about Stemson? This ist the company that got the huge investment and are what a lot of people are talking about.

 

https://stemsontx.com

[JDEE0]

Yeah, Stemson is exciting too, but that is hair cloning/re-generation, so I didn't include it in my list as its not really in the same category of a preventative/re-growth/maintenance treatments per se.

There are a number of big players in the hair cloning race apart from Stemson and Tsuji, such as L'oreal and some others I can't remember off the top of my head. I do think we will get there in terms of cloning at some point, but who knows when. Would be good to get an update from Tsuji at some point as they are ready for clinical trials, well, according to themselves anyway. 

I'm more hopeful for these other treatments that are far more feasible and likely far more accessible and useful for most people, but I think the next 10-20 years will generally see hair loss 'cured' via a number of different methods. 

[SD1984]

8 hours ago, JDEE0 said:

Yeah, Stemson is exciting too, but that is hair cloning/re-generation, so I didn't include it in my list as its not really in the same category of a preventative/re-growth/maintenance treatments per se.

Oh, I had thought Stemson was going to be injections of sorts that regrow hair. Isn't that what it was all about with the mouse they regrew hair on in 2019?

 

10 hours ago, Gatsby said:

for 37 you still have a remarkable amount of hair. Many men are bald by 30 or earlier. 

Many men with AA you mean(?), yes.

I'm still a bit nervous though, given my rather significant retrograde alopecia, recessed sides and overall poor hair quality, that those may be signed I may end up a NW7 one day like my grandfather was. What do you think?

[Gatsby]

I think every prospective patient must consider the possibility that one day they will/may end up a Norwood 6/7 to be on the safe side and plan surgery accordingly. This way you are utilizing the most of a finite donor supply. If you are fortunate enough to be able to tolerate and respond to Finasteride then you are ahead of the back. Even then though people do record that after some years the drug has lost its lick to a degree. Hair transplant surgery at the end of a day is not only a science, but moreso an art in the end. Their are just so many variables. To mitigate this research is a must.

[aaron1234]

17 hours ago, SD1984 said:

-There is literally no part of the top my scalp that is not thinning.

If this is really the case then expect the HT to thin overtime as well, especially if you're not on fin.  Doesn't mean getting a HT won't be of positive value for you, just be prepared for gradual thinning after the 12 month peak.  

[SD1984]

7 minutes ago, aaron1234 said:

If this is really the case then expect the HT to thin overtime as well, especially if you're not on fin.  Doesn't mean getting a HT won't be of positive value for you, just be prepared for gradual thinning after the 12 month peak.  

Yeah I've thought of that, and it really sucks, but I know it's a good possibility. 

[deeznuts]

Have you tried oral minox or topical fin/dut? 

1 hour ago, aaron1234 said:

If this is really the case then expect the HT to thin overtime as well, especially if you're not on fin.  Doesn't mean getting a HT won't be of positive value for you, just be prepared for gradual thinning after the 12 month peak.  

I always thought the thinning was age related thinning. Though I guess you'll also have some some miniaturization in the donor as a possibility, most doctors won't operate if it's significant

 

[deeznuts]

1 hour ago, Gatsby said:

I think every prospective patient must consider the possibility that one day they will/may end up a Norwood 6/7 to be on the safe side and plan surgery accordingly. This way you are utilizing the most of a finite donor supply. If you are fortunate enough to be able to tolerate and respond to Finasteride then you are ahead of the back. Even then though people do record that after some years the drug has lost its lick to a degree. Hair transplant surgery at the end of a day is not only a science, but moreso an art in the end. Their are just so many variables. To mitigate this research is a must.

From Dr. Wong's IG live Q&A, he mentioned that they can generally fairly reliably predict a patients future loss and that maybe only a couple patients progressed to a NW7 contrary to their predictions. I don't remember his exact phrasing though but it seemed like for the most part, it doesn't get super unpredictable

[aaron1234]

41 minutes ago, deeznuts said:

I always thought the thinning was age related thinning. 

Yes, but not exclusively.